Case Study: Traumatic Brain Injury and Intimate Partner Violence (IPV)

Abstract

This fictional case study was created with the purpose to shed light on the possible mechanism of injury, symptoms, resultant deficits and possible rehabilitation program of an individual with a traumatic brain injury (TBI) acquired through domestic violence.  This case documents the patient from initial inpatient care at the hospital through to discharge to home care.  Included in this case presentation is a background overview of TBI acquired through intimate partner violence (IPV), our fictional client characteristics, the examination findings, the intervention and rehabilitation program and the outcomes.  

The fictional client is a 33-year old female presenting with a moderate traumatic brain injury acquired through intimate partner violence on the same day of admission to the hospital. Damage was sustained to the right parietal and temporal lobes. Patient lost consciousness for approximately 40 minutes and could only remember events from about 1 week before the injury. Patient scored a 12 on the Glasgow Coma scale (GCS) and a 2 (moderate injury) on the Abbreviated Injury Scale at intake to hospital.  Upon initial assessment, beginning after day 3 of intake, patient presents with left sided hemiparesis, high tone in both extremities on left side, with greater range of motion loss and strength deficits, as well as increased spasticity in the left upper extremity (UE). Sensation examination found positive upper motor neuron tests and abnormal reflexes on the left side. Cortical sensations are also diminished on the left side. The patient scored a Stage 3 of motor recovery on the Chedoke McMaster Stroke Assessment (CMSA) and requires supervision with activity according to the Activity Inventory.  Balance and gait show great deficits as the Timed Up and Go test indicates she is at an increased risk of falls. In terms of a cognitive assessment, the patient scored a 66 on the Galveston Orientation and Amnesia Test (GOAT) administered by a neurologist, indicating she is still experiencing memory deficits. The patient displays preservation and confabulation and some uncharacteristic aggressive behaviour, however patient does present with a history of depression. The patient was determined to be at level 4, confused-agitated according the Ranchos Los Amigos, Level of Cognitive Functioning (LOCF) Scale, four days after initial intake to inpatient care.   

Patient rehabilitation began day 4 after intake into hospital. Her LOCF increased to a level 5, confused inappropriate when rehab commenced. She receives 3 hours of therapy every day, 5 days a week with a rehab team including physiotherapists, physiotherapy assistant, nurses and occupational therapists. With the goal of improving activities of daily living and functional ambulation, her treatment program consists of gait and balance training, range of motion exercises, contracture prevention techniques, and functional strength training. As her physiotherapist, working daily with the patient, her mental health and cognitive functioning will be monitored and taken into consideration for what type of treatment is warranted on a day to day basis. 

OUTCOME MEASURES 

During inpatient rehabilitation, the patient will also be cared by a social worker and psychologist to help cope with the effects of the intimate partner violence and she will be educated and supported on her options for support groups, safety planning and return to home life. After 42 days of inpatient care, the patient improved in her physiotherapy related outcome measured and is safely discharged to her mother’s house with help from the occupational therapist to determine her specific needs. She will continue to receive home physiotherapy care to improve her independent functioning. As well as support from the social worker and psychologist to assist her in managing her mental health as a result of domestic abuse.